The Department of Veteran Affairs (the “VA”) continues to struggle to provide effective therapy for Veterans with PTSD and TBI. As such, SFTT has decided to focus most of its attention on helping Veterans and their families cope with the ravages of the silent wounds of war.

The devastating effect of brain injury for hundreds of thousands of Veterans and their families cannot be underestimated. While SFTT will focus primarily on “new” therapy programs, we will occasionally report on the very unsettling problems faced by Veterans and their families as they seek to recover their lives.

Some “alternative” therapies have already proven to be quite successful, but many others are not widely known to Veterans or the medical profession at large. Even if these programs were endorsed or approved by the VA, treatment is often beyond the financial means of most Veterans.

While SFTT will let the “news” speak for itself, the science of treating brain injury is still in its infancy. SFTT attempts to provide balanced reporting of the pros and cons of these emerging therapy programs but strongly encourages the reader to make up their own mind as to their efficacy.

Hyperbaric Oxygen Therapy or “HBOT”

Among the most promising therapies is hyperbaric oxygen therapy or “HBOT,” Essentially, HBOT consists of a series of controlled dives in a compression chamber where Veterans receive oxygen under pressure. Many independent research studies have confirmed the efficacy of HBOT, but the VA and the DoD have consistently claimed that there is limited evidence to sustain the assertion that HBOT helps to improve brain function.

Despite the VA’s policy, many countries use HBOT to treat brain injury. In fact, the Israel Defense Forces (“IDF”) use HBOT to treat any concussive event for its military personnel. SFTT has written often about the efficacy of HBOT.

Nevertheless, VA spokesperson Dr. David Cifu continues to claim that current VA program are more effective than HBOT. The clinical evidence strongly suggests that Dr Ciful is misleading Veterans, Congressional subcommittees that oversee the VA and the public about the lack of efficacy of HBOT. SFTT will fully address Cifu’s “misspeaks” and “questionable” scientific evidence at a later date.

MDMA for PTSD Enters Final Trials

According to an article published in Newsweek, the final round of clinical trials for MDMA assisted psychotherapy could lead the way for the United States to approve the drug for therapeutic use as early as 2021.

The third and final phrase of trials gets underway after the Food and Drug Administration (“FDA”) designated MDMA as a “breakthrough therapy” for post-traumatic stress disorder (PTSD) in August 2017, ensuring that it will work with advocates to complete the last phase quickly.

MDMA, or 3,4-methylenedioxy-methamphetamine, is an empathogen, meaning that it stimulates togetherness and trust among users. It also inhibits activity in the brain that treats fear and stimulates hormones that make people feel more connected. While some may refer to MDMA and ecstasy interchangeably, MDMA is the pure form of the drug, while ecstasy can be cut with unknown adulterants.

SFTT Commentary: SFTT has written several times about the use of MDMA (aka “Ecstasy”) in treating PTSD. While final trial results for MDMA will not be known for several years, it is worth remembering that drugs that treat behavioral or pain symptoms but produce no long-lasting improvement in brain function may not be cause for celebration. Let’s face it, the President’s Final Report on Combating Drug Addiction (page 20) states quite clearly that “the modern opioid crisis originated within the healthcare system.” Will another drug prove more effective?

Written Exposure Therapy “WET”

According to a press release by Marilynn Larkin for the Psych Congress Network, “Written Exposure Therapy (“WET”) is noninferior to first-line cognitive processing therapy (CPT) for treating posttraumatic stress disorder (PTSD) and can be delivered in fewer sessions, researchers say.”

WET involves writing about a traumatic experience under clinical guidance, using a structured format.

“Our study has important implications for clinicians, as it suggests that PTSD can be effectively treated using a much shorter, less burdensome intervention – i.e., five sessions, minimal face-to-face time with the therapist, no between-session homework assignments – than what is typically used in clinical practice,” Dr. Denise Sloan of National Center for PTSD, VA Boston Healthcare System, told Reuters Health.

SFTT Commentary: The suggestion that WET is “noninferior to first-line cognitive processing therapy (“CPT”) is hardly a ringing endorsement. Despite VA propaganda to the contrary, CPT has been largely unsuccessful in treating Veterans with PTSD.

SFTT readers are encouraged to drop us a line if they discover an interesting new therapy to treat PTSD or TBI or would like to share a public interest story. SFTT can be reached at info@sftt.org.

As reported earlier, the Department of Veterans Affairs (“the VA”) is now providing hyperbaric oxygen therapy of “HBOT” on a trial basis to Veterans with PTSD and TBI. This marks an abrupt turnaround within the VA that has repeatedly claimed that there is insufficient clinical “evidence” to support the use of HBOT in treating Veterans with brain injuries.

The VA’s position reportedly stems from some 32 “inconclusive” studies on the effectiveness of HBOT in treating TBI and PTSD. Most recently, the 2015 DoD trial of HBOT concluded that there was a “lack of evidence” that HBOT helped Veterans with PTSD or TBI.

Col. Miller, the DoD project manager, “didn’t see any value in moving forward with more studies.” As SFTT reported earlier, Col. Miller is an infectious disease specialist and not a brain trauma specialist. Fortunately, he now works for the Gates Foundation focusing on his specialty: infectious disease.

The VA and the DoD go to great lengths to discredit the use of HBOT in treating Veterans with brain injury. Nevertheless, their arguments seem rather spurious against the almost overwhelming scientific evidence that HBOT is effective in helping to improve brain functionality.

Some in the medical profession have questioned whether test protocols in the DoD 2015 study were manipulated to produce the “inconclusive” outcome. More to the point, how is it possible for the VA to continue to defend its ONLY two non-invasive therapy programs: Prolonged Exposure Therapy (“PE”) and, Cognitive Processing Therapy (“CPT”)? Patient outcomes for these two programs have been shown by independent studies to be next to useless.

Hopefully, the lack of any meaningful success in treating PTSD and TBI has forced the VA to accelerate its exploration of alternative therapies. Hopefully, HBOT will soon be incorporated into the treatment options currently provided to Veterans by the VA.

“In essence, our mental attitude is that we must take care of ourselves and through that process little Israel has become a blessing for the rest of the world…we treasure our soldiers, young and old. They are our only defenders….no one else will fight our battles. You can imagine that every concussive event will be treated with HBOT !” . . .“the policy of the IDF is that life has the highest value and they are committed to use any treatment, in any case, to save a life”.

Furthermore, as Dr. Paul Harch and others have pointed out, there are many independent scientific studies confirming the benefits of HBOT. Specifically, Dr. Xavier Figueroa has written a compelling argument suggesting that the VA has dropped the ball on HBOT research.

There is plenty of anecdotal evidence to suggest that Veterans are seeking treatment centers all across the United States. In many cases, clinics are opening their doors to Veterans to help them recover from the silent wounds of war. Nevertheless, the treatment can be quite expensive as remains out of financial reach for most Veterans.

While Veterans and their support givers cope with this devastating war wound, SFTT remains hopeful that HBOT and other alternative therapy programs will soon be adopted by the VA to help these brave Veterans recover their lives.

Found below is an old (2012) but compelling video (caution, it takes a while to load) from a TV Station in Louisiana (WWL.com) which shows the remarkable recovery of Maj. Ben Richards mental and motor skills after having received treatment from Paul Harch:

While HBOT may not be “right” solutions for all Veterans suffering from brain injury, it does seem a far more compelling treatment alternative to the ineffective programs currently offered by the VA. More to the point, HBOT is non-invasive which suggests that we won’t have a new generation of addicts to contend with given failed VA programs.

As SFTT reported earlier, the VA will soon be providing a limited number of Veterans with access to hyperbaric oxygen therapy or “HBOT” at the VA’s Center for Compassionate Innovation (“CCI”) facilities in Texas and Oklahoma.

SFTT has yet to learn when these programs will begin or how many Veterans will be enrolled in these initial programs. As important, SFTT and the HBOT community at-large is interested in learning how “test protocols,” “metrics,” and “clinical trials” will be set by the VA and DoD to determine the benefits of HBOT.

As one sorts through the often nasty exchanges between proponents of HBOT and the VA gatekeepers like Dr. David Cifu, one cannot be oblivious to the fact that the VA does not want to encourage the adoption of HBOT in treating Veterans with PTSD and TBI.

The VA’s claim is that “patient outcomes’ using HBOT are inconclusive based on VA and DoD trials.

Could it be – as many have suggested – that the test protocols were flawed to produce “inconclusive” test results? From SFTT’s experience in monitoring the DoD, it would NOT BE THE FIRST TIME that test procedures have been deliberately modified to produce outcomes more to the liking of current military dogma.

Many will argue that further HBOT tests are not required given the wealth research currently available. In fact, found below is an extract from a Jan, 2017 report:

Xavier A. Figueroa, PhD and James K. Wright, MD (Col Ret), USAF Hyperbaric Oxygen: B-Level Evidence in Mild Traumatic Brain Injury Clinical Trials. Neurology® 2016;87:1–7 “There is sufficient evidence for the safety and preliminary efficacy data from clinical studies to support the use of HBOT in mild traumatic brain injury/ persistent post concussive syndrome (mTBI/PPCS). The reported positive outcomes and the durability of those outcomes has been demonstrated at 6 months post HBOT treatment. Given the current policy by Tricare and the VA to allow physicians to prescribe drugs or therapies in an off-label manner for mTBI/PPCS management and reimburse for the treatment, it is past time that HBOT be given the same opportunity. This is now an issue of policy modification and reimbursement, not an issue of scientific proof or preliminary clinical efficacy.”

While Secretary Shulkin is wise to proceed slowly, he must exercise extreme caution in allowing the naysayers within the VA any authority over the initial CCI HBOT trial programs.

HBOT Infrastructure in Place to Help Veterans

Assuming the VA leadership can get beyond the hurdles they largely created, Veterans with “mild TBI” and “persistent” PTSD should be able to quickly access hundreds of HBOT facilities across the United States. With equipment already in place around the country in hospitals and private health clinics, there is no need to hold up treatment for Veterans to wait for the VA to outfit its facilities.

Clear treatment protocols and directives need to be established for each private clinic providing HBOT to Veterans. HBOT is administered in a series of dives or sessions (usually between 28 and 40) over a 6 week to 2 month time frame. Supervision by a trained clinician is required at each dive. Clearly, a larger “dive chamber” capable of offering therapy to a number of Veterans at the same will help bring down the costs of HBOT.

Costs “per dive” or “session” vary significantly around the country. Some hospitals charge $1,800 per session, but most private clinics offer this service at a cost of between $250 and $350 per dive. Given the bargaining power of the VA, it seems most likely that a series of battery of dives can be accomplished for well under $10,000, which is less than half of what the VA currently spends on Veterans with TBI/PTSD.

As SFTT has stated on many occasions, HBOT is not the “silver bullet” to eradicate this silent wound of war, but many more Veterans with brain trauma will begin to be able to reclaim their lives with less reliance on VA prescription drugs that simply mask symptoms rather than provide any lasting improvement in brain functionality.

This could be a BIG DEAL for ailing Veterans and family members who provide our Veterans such caring support.